///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

An opioid-free cesarean delivery in the opioid addicted parturient with the use of the quadratus lumborum block: A Case Report

Abstract Number: RF5AH-323
Abstract Type: Case Report Case Series

Justin C Swengel MD1 ; Craig Towers MD2; Carrie Polin MD3

An opioid-free cesarean delivery in the opioid addicted parturient with the use of the quadratus lumborum block: A Case Report

Opioid addiction is a major issue affecting many parturients across the United States. Classic thoughts on opioid abuse in pregnancy led to the practice of maintaining parturients on opioid therapy, however, more recent studies have shown parturients can successfully be weaned off opioids without risk to the mother or fetus.1 At our institution, many parturients who are weaned from opioids are transitioned to naltrexone maintenance therapy. These patients desire to remain opioid free after cesarean delivery in order to prevent relapse; however historically have required opioids to manage their pain postoperatively. The quadratus lumborum block (QL block) has been shown to provide postoperative analgesia following cesarean delivery.2 These case reports demonstrate patients on naltrexone maintenance therapy who received a QL block in addition to multimodal analgesia for postoperative pain management.

Case 1: A 38 y/o G5P3 at 39 weeks gestation presented for repeat cesarean delivery with bilateral tubal ligation. Her medical history included obesity (BMI 44) and prior opioid abuse being maintained on naltrexone 50mg daily. For her cesarean delivery, she received a spinal anesthetic with 12mg bupivacaine, 15mcg fentanyl, 150mcg of morphine, and 60mcg clonidine. At the end of the case, bilateral QL blocks were placed with 30cc (each side) of 0.33% ropivicaine. In the postoperative period, the patient’s pain was controlled with scheduled acetaminophen, ketorolac and ibuprofen. No opioids were utilized in post-operative period and the patient was able to receive intramuscular naltrexone prior to discharge.

Case 2: A 27 y/o G5P4 at 39 weeks gestation presented for repeat cesarean delivery with bilateral tubal ligation. Her medical history was pertinent for depression, GERD, anemia, and prior substance abuse on maintenance naltrexone 50mg daily. She underwent a spinal anesthetic with 12mg bupivacaine, 15mcg fentanyl, 150mcg morphine, and 60mcg clonidine. At the end of the surgical case, the patient received bilateral QL blocks with 30cc (each side) of 0.33% ropivicaine. Her postoperative pain was managed with ketorolac, ibuprofen, and acetaminophen. At the end of her hospital stay, the patient was reinitiated on her naltrexone and was able to receive intramuscular naltrexone prior to leaving the hospital.

These two cases illustrate the use of QL blocks to allow parturients on naltrexone maintenance therapy to remain opioid free in the perioperative period after major abdominal surgery. In this patient population, avoiding opioids during this time period can allow continuation of their naltrexone with possible prevention of relapse into drug abuse.

1. Bell J, Towers C, et al. Am J Obstet Gynecol. 2016 Sep;215(3):374e1-6.

2. Blanco R, et al. Reg Anesth Pain Med. 2016 Nov/Dec; 41(6):757-762

SOAP 2019